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KROGER PHARMACY
CH051741H SHALOM HEALTH CARE CENTER, INC.
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Covered Entity Details
Entity Name
SHALOM HEALTH CARE CENTER, INC.
Subdivision Name
SHALOM PRIMARY CARE CENTER
Type
HRSA-Funded Health Center
340B ID
CH051741H
Entity Address
3400 Lafayette Rd
Indianapolis, IN 46222-1146
Grant Number
H80CS00880
Participating Start Date
7/1/2018
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY
Pharmacy Address
5718 CRAWFORDSVILLE RD
INDIANAPOLIS, IN 46224
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/15/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Leonardo R. Ortega, Executive Director/CEO
(317) 291-7422 Ext: 1105
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/15/2019
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